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Pulmonary Embolism I: Introduction01:29

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Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Endocarditis can present various clinical features depending on the causative organism and the patient's underlying health conditions. Initially, the clinical features of infective endocarditis develop gradually, presenting with nonspecific symptoms that can be easily mistaken for other illnesses.General SymptomsEarly symptoms of infective endocarditis are fever, chills, weakness, malaise, fatigue, and weight loss. These symptoms reflect the systemic nature of the infection and the body's...
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Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
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Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
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Splenic Infarction at the Crossroads of Hematologic and Cardioembolic Risk.

George K Annan1, Enoch Enninful2, Nana Dwommoh3

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Summary

Splenic infarction can occur in patients with chronic myeloid leukemia (CML) and atrial fibrillation. Managing this requires balancing anticoagulation with bleeding risks for optimal outcomes.

Keywords:
atrial fibrillationchronic myeloid leukemiacmlhyperleukocytosissplenic infarctionthromboembolic complications

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Area of Science:

  • Hematology
  • Cardiology
  • Oncology

Background:

  • Splenic infarction is a rare complication of hematologic malignancies and cardioembolic disorders.
  • Chronic myeloid leukemia (CML) with hyperleukocytosis and thrombocytosis creates a prothrombotic state.
  • Atrial fibrillation is a known risk factor for systemic embolism.

Observation:

  • A 76-year-old woman with T315I BCR-ABL1 CML, paroxysmal atrial fibrillation, and hypertension presented with abdominal pain.
  • Imaging confirmed splenic infarction; labs showed leukocytosis and thrombocytosis.
  • The patient received fluids, analgesia, heparin, and later apixaban for anticoagulation.

Findings:

  • Disease-directed therapy with asciminib and hydroxyurea achieved a partial hematologic response.
  • The patient was managed with a careful balance of anticoagulation and malignancy treatment.
  • At three-month follow-up, she had no recurrent thrombosis, bleeding, or abdominal symptoms.

Implications:

  • This case highlights the complex etiology of splenic infarction in patients with combined hematologic and cardiovascular risks.
  • Timely diagnosis via imaging and careful anticoagulation management are crucial.
  • Individualized, multidisciplinary care and long-term follow-up are essential for managing these complex cases.